1 00:00:14,88 --> 00:00:15,84 OK you're leaving 2 00:00:16,29 --> 00:00:20,54 a welcome folks here for the May twenty seventh two thousand for keeping our 3 00:00:20,55 --> 00:00:25,84 workshop the focus workshops are going to be on on health plans and things related 4 00:00:25,85 --> 00:00:30,14 to the health plans I think we're probably going to get more information on them 5 00:00:30,45 --> 00:00:34,68 and the kind of decisions of the suspect will have more meetings in the future 6 00:00:34,69 --> 00:00:35,92 whatever group where we get 7 00:00:35,96 --> 00:00:42,25 a lot about race questions bites into some things at all the role of employers are 8 00:00:42,26 --> 00:00:46,58 here so we're also most what we call them later so I'm sort of the sort of very 9 00:00:46,91 --> 00:00:50,63 strong Thank you Mr Mayor I want to introduce in case you haven't had 10 00:00:50,64 --> 00:00:55,97 a chance to meet yet Graham Beaudry She's with the Horton group she's our health 11 00:00:55,98 --> 00:01:01,30 insurance consultant she works with us on getting proposals together requests for 12 00:01:01,31 --> 00:01:05,65 proposals and or evaluating proposals and pretty much evaluating our health 13 00:01:05,66 --> 00:01:07,63 insurance program and she's been with us for 14 00:01:07,64 --> 00:01:14,38 a number of years. The purpose of our work session today I want to just go 15 00:01:14,39 --> 00:01:18,96 back to one of the council's goals that they set for me for the year was head to do 16 00:01:18,97 --> 00:01:21,38 with health insurance you asked me to conduct 17 00:01:21,39 --> 00:01:25,00 a structural review of our health insurance program so we're going to talk 18 00:01:25,01 --> 00:01:29,16 a little bit about that today identify ways to control the city's increasing costs 19 00:01:29,36 --> 00:01:33,28 and contributions for health insurance and overall benefit package and then 20 00:01:33,29 --> 00:01:38,83 a plan to develop phase in changes over time that's that's not going to be achieved 21 00:01:38,84 --> 00:01:42,65 today but really setting the table so that we can achieve that goal that the 22 00:01:42,66 --> 00:01:46,40 Council has set for me. To do that there's 23 00:01:46,41 --> 00:01:50,21 a brief presentation out I want to go over where our current health benefits 24 00:01:50,22 --> 00:01:55,94 structure is so you know where we're at also compare ourselves to some comparable 25 00:01:55,95 --> 00:01:58,43 agency and I'm going to give you 26 00:01:58,44 --> 00:02:02,01 a brief overview of it but I'm going to give you some things to take home that give 27 00:02:02,02 --> 00:02:02,21 you 28 00:02:02,22 --> 00:02:08,97 a. More of the wide survey results that we conducted. And then local private employers 29 00:02:08,98 --> 00:02:12,67 were included in that we don't have them specifically just by name but you're going 30 00:02:12,68 --> 00:02:13,98 to see a profile of them you have 31 00:02:13,99 --> 00:02:17,66 a fairly good idea of their substantial employers we just didn't take 32 00:02:17,67 --> 00:02:22,35 a small mom and pop operation then some of the environmental realities and 33 00:02:22,36 --> 00:02:23,08 challenges that's 34 00:02:23,09 --> 00:02:27,52 a nice way of saying things going on in the market the Affordable Care Act its 35 00:02:27,53 --> 00:02:33,01 impact on us those changes while they're not impacting us immediately they're very 36 00:02:33,02 --> 00:02:37,45 much on the horizon and then strategies things opportunities challenges things that 37 00:02:37,46 --> 00:02:42,07 we're to be looking at and then discussion in decisions anything that the council. 38 00:02:43,87 --> 00:02:49,66 Reacts to initial reactions What's to look more into or are concerns that that you 39 00:02:49,67 --> 00:02:55,97 see from our presentation today. The current play and. 40 00:02:57,49 --> 00:02:58,62 We want to talk about 41 00:02:58,63 --> 00:03:03,21 a little bit but we want to go back to the health insurance focus group which 42 00:03:03,42 --> 00:03:05,83 becomes a better report on that last year and 43 00:03:05,84 --> 00:03:09,46 a lot of it was because we knew even last year that we were facing 44 00:03:09,47 --> 00:03:14,27 a twenty percent increase in our health insurance costs as we were approaching 45 00:03:14,31 --> 00:03:20,35 twenty fourteen. And we knew that our health insurance fund our own internal fund 46 00:03:20,36 --> 00:03:27,05 a manager's. Our health insurance was facing some cashflow is true remind everybody 47 00:03:27,06 --> 00:03:33,57 we have we are up partially self which are we cover all the costs up to seventy 48 00:03:33,58 --> 00:03:38,33 five thousand dollars per individual and then anything above seventy five thousand 49 00:03:38,45 --> 00:03:43,29 is covered through stop loss insured so we do have insurance for cost about seventy 50 00:03:43,30 --> 00:03:49,85 five thousand but every cost up to seventy five thousand we we pay for all of those 51 00:03:49,86 --> 00:03:55,80 costs that come in. We also had it as you found out when we were talking about this 52 00:03:55,81 --> 00:03:56,46 last year 53 00:03:56,70 --> 00:04:03,11 a lot of shock losses which are losses in excess of seventy five thousand 54 00:04:03,46 --> 00:04:07,60 which we've been exceeding the industry average for for years so we've had 55 00:04:07,61 --> 00:04:11,85 a rough time and every employer that has a 56 00:04:12,09 --> 00:04:16,29 a self-assured program goes through some rough times and we have certainly hit our 57 00:04:16,30 --> 00:04:21,77 rough times. But we're also seeing that our healthy employees are leaving the 58 00:04:21,78 --> 00:04:26,40 program or more to say we also have other employees who are sticking with the 59 00:04:26,41 --> 00:04:28,49 program for older I think it's 60 00:04:28,50 --> 00:04:33,93 a matter of of variety of things one thing is just natural demographics our aging 61 00:04:33,94 --> 00:04:39,24 workforce that's just a natural phenomenon that we're dealing with. As we have 62 00:04:39,25 --> 00:04:43,90 a limited positions because to say we've laid off is really an exaggeration we've 63 00:04:43,91 --> 00:04:48,52 eliminated positions and we've normally done that through attrition but when you 64 00:04:48,57 --> 00:04:52,97 when you eliminate positions through attrition you're by nature keeping older 65 00:04:52,98 --> 00:04:57,28 employees because you're not back filling them with new employees so you're 66 00:04:57,29 --> 00:05:02,49 generally getting an older workforce and older employees have more medical issues 67 00:05:02,50 --> 00:05:06,97 that just by definition I mean that group so I know that I'm not seen anything out 68 00:05:06,98 --> 00:05:13,33 of school we're all there. But bet because we have more employees. 69 00:05:14,81 --> 00:05:21,63 Healthy employees leaving or not getting onto the plan are groups older more costs 70 00:05:21,63 --> 00:05:28,41 . Employees are evaluating the premium costs I like to refer to it as 71 00:05:28,42 --> 00:05:33,30 a kitchen table conversation where the two spouses are discussing health insurance 72 00:05:33,49 --> 00:05:37,49 they may have both been covered by health insurance under their under their current 73 00:05:37,50 --> 00:05:42,16 employer and when it was only three to five percent of the premium share you were 74 00:05:42,17 --> 00:05:46,73 paying and it was easy to say let's both have health insurance but as time goes on 75 00:05:46,74 --> 00:05:52,73 is going on premium cost of increased the kitchen table conversation is we we can't 76 00:05:52,74 --> 00:05:57,24 afford to have both of us get insurance what's one of us take insurance and the 77 00:05:57,25 --> 00:06:03,92 other one don't it will save us money but in reality we're paying more because now 78 00:06:03,93 --> 00:06:08,21 you have all those costs concentrated with one employer if we're that employer of 79 00:06:08,22 --> 00:06:14,44 choice which in many cases we have been our costs go up but we're still charging 80 00:06:14,45 --> 00:06:19,27 the same amount those are the factors that are part of the twenty percent it's not 81 00:06:19,28 --> 00:06:20,68 just because we've had 82 00:06:20,69 --> 00:06:27,47 a run of bad luck the demographics are are definitely working against us. We 83 00:06:27,48 --> 00:06:29,30 brought the employees together they talked about 84 00:06:29,31 --> 00:06:35,11 a lot of things they liked the broad network that was in our P.P.O. 85 00:06:35,12 --> 00:06:42,04 Our preferred provider plan. They recognized through this discussion that they had 86 00:06:42,25 --> 00:06:46,50 that usage does drive the premium so they feel ploys are beginning to recognize at 87 00:06:46,51 --> 00:06:53,51 least amongst the group that we've assembled that usage was driving this they they 88 00:06:53,52 --> 00:06:58,25 felt that people use the system more should pay more and there should be more of 89 00:06:58,26 --> 00:07:04,47 a direct relationship between usage and payment. At same time the employees like 90 00:07:04,48 --> 00:07:07,87 knowing what they were paying when they use the services similar to what the old 91 00:07:07,91 --> 00:07:08,56 E.P.O. 92 00:07:08,57 --> 00:07:12,76 Or the exclusive provider plan was they would like to know that if I go here I pay 93 00:07:12,77 --> 00:07:19,45 twenty dollars I go here I pay one hundred I go out of network I'm paying. Seventy 94 00:07:19,46 --> 00:07:25,03 percent for the insurance only covered seventy percent versus ninety or one hundred 95 00:07:25,04 --> 00:07:29,16 percent when you stayed in the network but the employees like knowing what their 96 00:07:29,17 --> 00:07:32,96 costs were. So as I mentioned we have 97 00:07:32,97 --> 00:07:38,04 a partially self funded plan that's our current method. We have looked at other 98 00:07:38,05 --> 00:07:43,90 options we have evaluated proposals from other places you may recall that we the 99 00:07:43,91 --> 00:07:48,14 discussion came out well why don't we go to the state plan. And I've been in the 100 00:07:48,15 --> 00:07:54,70 state plan in other employers and you know quality wise it's a plan it's 101 00:07:54,71 --> 00:07:58,54 a very good plan but there have been provisions that have been added in recent 102 00:07:58,55 --> 00:08:00,45 years for example there is 103 00:08:00,46 --> 00:08:05,48 a premium that they can charge your first two years in the program so even though 104 00:08:05,49 --> 00:08:09,57 it's technically less than our current payment when those premiums are added You're 105 00:08:09,58 --> 00:08:14,87 actually paying as much if not more than you're paying in under our current plan so 106 00:08:15,30 --> 00:08:15,58 there's 107 00:08:15,59 --> 00:08:19,86 a gradual phasing that you have to have because they don't want people jumping into 108 00:08:19,87 --> 00:08:24,22 the state plane and then jumping out so you can pay a premium of up to thirty is 109 00:08:24,23 --> 00:08:28,14 a thirty percent thirty to thirty two percent and then so. Eckstein the next year 110 00:08:28,33 --> 00:08:28,95 so you're paying 111 00:08:28,96 --> 00:08:33,00 a premium to get back into the plan because they're afraid you'll jump in the jump 112 00:08:33,01 --> 00:08:39,71 out. We still have found through our analysis that self funding 113 00:08:39,72 --> 00:08:43,83 remains the most cost effective option in the main reason being is because member 114 00:08:43,84 --> 00:08:49,39 self funded we don't have an insurance company on the front end building profit 115 00:08:49,40 --> 00:08:50,24 into it we're not 116 00:08:50,25 --> 00:08:56,58 a profit driven group so we don't have that so we're not charging ourselves at 117 00:08:56,59 --> 00:09:03,56 profit built in so that's kind of where we are with our plan right now I 118 00:09:03,57 --> 00:09:04,28 want to just take 119 00:09:04,29 --> 00:09:07,87 a quick break to see if there's anybody has any questions about how our current 120 00:09:07,88 --> 00:09:12,57 plan is this is all new for concert pianists keep but you know we only talk about 121 00:09:12,58 --> 00:09:13,34 this once or twice 122 00:09:13,35 --> 00:09:20,11 a year and anybody me questions. You mentioned 123 00:09:20,60 --> 00:09:25,36 spall sales if Tuesday two employees are married working for to see only one can 124 00:09:25,37 --> 00:09:30,81 take insurance all right that works out that way for yeah for us but is 125 00:09:30,82 --> 00:09:36,32 a brilliant or can't take it. Role and we only have one plan there that's only 126 00:09:36,33 --> 00:09:41,68 necessary for one it's when there are two employers two separate back lawyers just 127 00:09:42,04 --> 00:09:48,04 double check and yeah you clarify what shock losses are chock losses or anything 128 00:09:48,05 --> 00:09:51,36 above seventy five thousand dollars and there's also 129 00:09:51,37 --> 00:09:58,17 a term called lasered. If. And we can't disclose these because of HIPAA regulations 130 00:09:58,28 --> 00:09:59,97 but if we have an employee who or 131 00:10:00,01 --> 00:10:05,07 a dependent anybody who's covered by our plan who is significantly. 132 00:10:06,53 --> 00:10:09,09 Expensive they may ask us to have 133 00:10:09,10 --> 00:10:12,52 a two hundred thousand dollars shock loss and then we call it 134 00:10:12,53 --> 00:10:15,14 a laser because it's worse than 135 00:10:15,15 --> 00:10:21,74 a shock and it's we have that and we've had employees or their dependents and we've 136 00:10:21,75 --> 00:10:25,77 been paying the first two hundred thousand dollars so you can imagine when we have 137 00:10:26,49 --> 00:10:29,76 those shock losses that are higher than the industry average there's been 138 00:10:29,77 --> 00:10:32,67 a couple cases we've had more than one laser in 139 00:10:32,68 --> 00:10:37,30 a year so then instead of even paying the first seventy five it's two hundred you 140 00:10:37,31 --> 00:10:41,48 multiply that by two now instead of one hundred fifty thousand exposure it's one 141 00:10:41,49 --> 00:10:47,07 hundred it's four hundred thousand dollars over we've had those types of situations 142 00:10:47,07 --> 00:10:53,61 . And that's the conditions under which the reinsurer will take this because they 143 00:10:53,62 --> 00:10:57,03 know that person's going to exceed seventy five thousand and they're going to be 144 00:10:57,53 --> 00:11:02,85 paying all those every dollar over seventy five thousand the reinsurer covers they 145 00:11:02,86 --> 00:11:08,22 had systems on having these folks lasered And when we go out to bid we bid out to 146 00:11:08,49 --> 00:11:15,40 the. Stop loss insurance every year we say OK Company A Company 147 00:11:15,41 --> 00:11:17,01 B. But they all take 148 00:11:17,02 --> 00:11:21,45 a look at our plan and if they see those potentials they say we're going to laser 149 00:11:21,46 --> 00:11:25,80 this person we're going to laser that person it could be John Doe It could be John 150 00:11:25,81 --> 00:11:32,00 Doe's son could be Mary Jones or Mary Jones has been could be it could be anybody 151 00:11:32,01 --> 00:11:38,98 in the plan so it individuals get lasered Well then it's communicated to you or 152 00:11:38,99 --> 00:11:42,92 to Mr Fitzpatrick. Who the individual is and then as 153 00:11:42,93 --> 00:11:48,68 a communicated then to the employee No it's or no never OK oh that's just that's 154 00:11:48,69 --> 00:11:49,86 our it's just 155 00:11:49,87 --> 00:11:54,43 a consequence that's our cross that we bear in fact I don't know what I don't even 156 00:11:54,44 --> 00:11:58,67 own now. What generally happens is we've been able to stop loss on an annual basis 157 00:11:58,91 --> 00:12:03,34 I'll come with the best couple of packages we'll discuss them but even to Mr 158 00:12:03,35 --> 00:12:09,99 Fitzpatrick typically And to now Trina we don't disclose the plan participants and 159 00:12:10,00 --> 00:12:14,31 that would be in the final contract so one person will see that typically not an 160 00:12:14,32 --> 00:12:18,14 individual who can hire and fire at the city because we wouldn't want anybody to 161 00:12:18,15 --> 00:12:19,94 have a bad feeling about 162 00:12:19,95 --> 00:12:23,86 a person or or individual because of their individual health concerns create 163 00:12:24,43 --> 00:12:30,66 a rubber search over what we've probably already sort of correct on. One or two but 164 00:12:30,67 --> 00:12:35,98 if we get it change one year to you next year it's me I mean I just ask them how 165 00:12:36,30 --> 00:12:39,33 long we're going to remember what we have why do you have our orders are because 166 00:12:39,34 --> 00:12:45,59 we're just talking average of. One hundred that are laser we've had ten to twelve 167 00:12:45,60 --> 00:12:49,74 hit the seventy five and then some have over the last several years so when you 168 00:12:49,75 --> 00:12:52,34 think about that when you've got ten people that's three quarters of 169 00:12:52,35 --> 00:12:56,47 a million dollars right or we even get paid back from reinsurance and there were 170 00:12:56,60 --> 00:13:02,58 two Year two consecutive years that we had. About ten people they were different 171 00:13:02,63 --> 00:13:07,42 people each year so that wasn't ten people over two year period we had twenty 172 00:13:07,43 --> 00:13:12,79 different people hit that So then you can figure that the people who didn't hit the 173 00:13:12,80 --> 00:13:16,31 one year hit the next they're probably not going on that seventy five thousand 174 00:13:16,32 --> 00:13:22,42 dollars door anyway so significant dollars that we're talking about because we're 175 00:13:22,43 --> 00:13:25,91 only talking people who exceeded seventy five thousand fewer at seventy three or 176 00:13:25,92 --> 00:13:30,19 seventy four you weren't even counted in that number but that's I mean that's 177 00:13:30,20 --> 00:13:36,85 a lot of money when you start just single individuals but what point is that again 178 00:13:36,86 --> 00:13:39,65 I mean how do we know a person should be lasered has 179 00:13:39,66 --> 00:13:44,69 a past history or pretty insurance company figures out based on 180 00:13:44,70 --> 00:13:50,99 a track record we they what do they call and it's really what we've been well it's 181 00:13:51,00 --> 00:13:54,17 an underwriting process but what we've done in the past several years which has 182 00:13:54,18 --> 00:13:55,91 been a really good thing we've had what's called 183 00:13:55,92 --> 00:14:01,65 a conditional laser So for example if I was your I was one of your employees and I 184 00:14:01,66 --> 00:14:02,04 was going to get 185 00:14:02,05 --> 00:14:07,35 a kidney transplant they would say well we'll keep an eye on the regular stop loss 186 00:14:07,36 --> 00:14:10,45 policy seventy five but if she gets the kidney transplant then it's one hundred 187 00:14:10,46 --> 00:14:14,02 twenty five so I'd have the additional fifty but only if I got that transplant in 188 00:14:14,03 --> 00:14:18,79 that period of time so we've been really working very hard to keep the lasers to 189 00:14:18,80 --> 00:14:24,01 a minimum and we've had one to two over the last several years but we've been it's 190 00:14:24,02 --> 00:14:24,23 been 191 00:14:24,24 --> 00:14:28,72 a number of people getting to the seventy five thousand the reinsurance starts paying 192 00:14:28,73 --> 00:14:32,03 a minute immediately when we had seventy five thousand one dollars they start 193 00:14:32,04 --> 00:14:36,70 paying out of their own out of their own dollars but it's how many people have been 194 00:14:36,71 --> 00:14:41,36 getting to that point and when you think of medical inflation some of the things 195 00:14:41,37 --> 00:14:42,43 that didn't cost very much 196 00:14:42,44 --> 00:14:47,25 a few years ago and he and the replacement today as we get older Mark to Mark's 197 00:14:47,26 --> 00:14:49,100 point might be fifty five sixty thousand dollars if there's 198 00:14:50,01 --> 00:14:53,42 a complication that stop loss within 199 00:14:53,46 --> 00:14:57,54 a couple weeks of having an operation so it just started depends medical inflation 200 00:14:57,55 --> 00:15:03,58 has been pretty pricey. His it's just last for your fury it of. 201 00:15:05,00 --> 00:15:11,91 Rather in proportion to stop loss uses that affected our reinsurance rates. To 202 00:15:11,92 --> 00:15:13,19 a degree where that's been 203 00:15:13,20 --> 00:15:17,46 a concern nor has it been I would say rates have gone up yeah it's 204 00:15:17,47 --> 00:15:22,72 a bit but reinsurance this property casualty insurance so they tend to recognize 205 00:15:22,73 --> 00:15:26,86 that you're going to have hits and it's Kurtzer like your fire and flood insurance 206 00:15:26,87 --> 00:15:29,95 they know that it's coming here to have these few bad years and then you're going 207 00:15:29,96 --> 00:15:35,50 to sort of even out and that's how stop loss really works so well yes we've had 208 00:15:35,51 --> 00:15:38,74 great increases they've been pretty managed over time on 209 00:15:38,75 --> 00:15:43,27 a much smaller part of the premium dollar than you might think I think our total 210 00:15:43,28 --> 00:15:48,00 fixed costs are approximately eight to ten percent ninety percent is paid out 211 00:15:48,01 --> 00:15:54,51 directly in claims. It's double premiums correct they have it's our ongoing cost 212 00:15:54,52 --> 00:16:00,76 it's all those costs as rancid with the inflation then you know the replacement is 213 00:16:00,77 --> 00:16:01,88 sixty thousand dollars 214 00:16:01,89 --> 00:16:06,06 a few years ago maybe it was only you know forty thousand well that extra twenty is 215 00:16:06,07 --> 00:16:10,68 coming out of our pocket because it hasn't hit seven thousand and let's hope it 216 00:16:10,69 --> 00:16:15,82 doesn't but so inflation is really get us more then it's had to reinsure it's 217 00:16:15,83 --> 00:16:22,71 a good point so if the course of your. Talk about the some to four thousand or warm 218 00:16:22,83 --> 00:16:28,28 you get charges the charges got that we were talking about before George planned 219 00:16:28,35 --> 00:16:35,11 this culturally or whether we had four. However disco we're going to the other 220 00:16:35,12 --> 00:16:40,49 words of both We've got to carry more Dylan. One hundred thousand dollars bill at 221 00:16:40,50 --> 00:16:46,53 the disco seven thousand show you all three thousand. We put out our story 222 00:16:46,54 --> 00:16:51,56 obviously are going to say whether we pay the discounted feet for and the claims 223 00:16:51,60 --> 00:16:54,47 and we are roughly at approximately forty seven and 224 00:16:54,48 --> 00:16:58,31 a half percent discount so if we had one hundred thousand dollars charge we'd 225 00:16:58,32 --> 00:17:03,12 really be looking at roughly around fifty three. The one thing though that I would 226 00:17:03,40 --> 00:17:10,24 to your question and to yours. Is the seventy five has been at seventy five cents I 227 00:17:10,25 --> 00:17:13,36 started working with the city at that time you guys used to have one hundred twenty 228 00:17:13,37 --> 00:17:17,12 five thousand and then it was one hundred ten we've been bringing it down to keep 229 00:17:17,13 --> 00:17:22,01 your budget very very manageable when you think about medical inflation now it's 230 00:17:22,02 --> 00:17:25,47 easier to knock up against that seventy five but if you're thinking about ten 231 00:17:25,48 --> 00:17:28,86 claims had we gone to one hundred thousand we would have never saved enough in 232 00:17:28,87 --> 00:17:32,32 premium for you guys to take on that additional twenty five thousand and liability 233 00:17:32,33 --> 00:17:37,05 so we look at that each and every year or two so the cost against that seventy five 234 00:17:37,06 --> 00:17:41,43 is going up but it helps to manage your budget by keeping that stop loss limit lol 235 00:17:41,93 --> 00:17:46,20 in the ring it's going to when we had a little more of a cushion in 236 00:17:46,21 --> 00:17:50,42 a reserve we did buy down with that so it wouldn't be such 237 00:17:50,43 --> 00:17:52,62 a catastrophic it and we also had 238 00:17:52,63 --> 00:17:59,35 a transplant right that's proved to be pretty effective. To 239 00:17:59,73 --> 00:18:03,42 I think it was shortly after Mark got here we talked to Mark about that and he said 240 00:18:04,02 --> 00:18:05,48 let's go forward with it and that was 241 00:18:05,49 --> 00:18:09,88 a good decision by going back to what you just said I was going to be my question 242 00:18:09,89 --> 00:18:15,26 about raising that some if I don't know the workforce but it makes sense to bring 243 00:18:15,27 --> 00:18:18,30 it up. But we get your point your game lean 244 00:18:18,31 --> 00:18:22,48 a little bit that you may have health issues but well it has it's really not as 245 00:18:22,49 --> 00:18:22,75 much of 246 00:18:22,76 --> 00:18:26,37 a gamble as you would think because at what at the end of the day every time we 247 00:18:26,38 --> 00:18:28,53 shop this we ask the carriers for 248 00:18:28,54 --> 00:18:32,43 a seventy five and eighty will go all the way up and then. We decided OK did we 249 00:18:32,44 --> 00:18:35,60 save enough in premium if we know we've got four people that are probably going to 250 00:18:35,61 --> 00:18:39,87 hit again OK are we going to save that twenty thousand to go to eighty are we going 251 00:18:39,88 --> 00:18:44,60 to save that you know and usually the honest answer has been no seventy five is 252 00:18:44,61 --> 00:18:50,48 a pretty good level because most regular stuff stays under that it's going to be 253 00:18:50,49 --> 00:18:54,64 the transplants it's going to be the big cancers that are going to go over that and 254 00:18:54,65 --> 00:18:59,09 we want that protection for the plan particularly when we're struggling to manage 255 00:18:59,10 --> 00:19:03,34 budgets it's worth it to keep our maximum out of pocket at 256 00:19:03,35 --> 00:19:09,75 a really good level things. What are the details in the transplant right or what 257 00:19:09,76 --> 00:19:16,34 does that entail. The transplant rider allows us to not only the 258 00:19:16,35 --> 00:19:21,23 financial protection but also it has some medical management portions based built 259 00:19:21,24 --> 00:19:27,88 into it so when employees there are going to see they can have 260 00:19:28,31 --> 00:19:33,66 the assistance of medical management training the whole. Understand the process 261 00:19:33,70 --> 00:19:40,27 help them go through. All the mechanics of the transplant itself 262 00:19:40,41 --> 00:19:47,02 what where to go to look for how the process works. As it's also 263 00:19:47,03 --> 00:19:51,43 after care any complications just from the date of 264 00:19:51,44 --> 00:19:54,99 a transplant for three hundred sixty five days following it one hundred percent of 265 00:19:55,00 --> 00:19:59,39 the charges are covered for the employee and the employer so it doesn't come 266 00:19:59,40 --> 00:20:03,08 together for the stop loss it doesn't count the employee has no deductible no out 267 00:20:03,09 --> 00:20:06,91 of pocket and that includes their immunosuppressant drugs the great thing about 268 00:20:06,92 --> 00:20:08,64 that is they can then go always to 269 00:20:08,65 --> 00:20:12,68 a center of excellence know that they've got great care and if they're going to be 270 00:20:12,69 --> 00:20:15,04 taking care of afterwards it does I don't have to have 271 00:20:15,05 --> 00:20:18,59 a second mortgage on my house or try to sell my first one to get 272 00:20:18,60 --> 00:20:20,29 a twenty inch incision but it was also 273 00:20:20,30 --> 00:20:25,43 a good decision from the employee present. Unfortunately we've had to have some 274 00:20:25,44 --> 00:20:30,99 employees that you know and we had good success with them I think there's 275 00:20:31,00 --> 00:20:35,18 a mantra. Amount of money that even our plan covers for 276 00:20:35,43 --> 00:20:42,18 a transplant so if we didn't have the writer once that Max was left or exceeded 277 00:20:42,38 --> 00:20:48,56 the employee was going to assume the loss that was several hundred thousand dollars 278 00:20:48,57 --> 00:20:55,15 just leave was the cap but if it went over that which it would. Almost guarantee 279 00:20:55,16 --> 00:21:00,40 because of the whole year afterwards and complications that result from that. You 280 00:21:00,41 --> 00:21:07,24 could find an employee with an extreme. Financial liability you talk about second 281 00:21:07,25 --> 00:21:12,41 mortgages and things and not only that the grand mansion sues some of the drugs for 282 00:21:12,42 --> 00:21:16,74 immunosuppressants you know they are they can be extremely costly can be twenty 283 00:21:16,75 --> 00:21:17,30 thousand dollars 284 00:21:17,31 --> 00:21:22,33 a month this is for the drugs the program the rejection of Ogun organs so it's it's 285 00:21:22,34 --> 00:21:23,95 a very soon to avoid 286 00:21:23,96 --> 00:21:28,22 a laser because by doing that by getting that type of coverage we also avoided 287 00:21:28,23 --> 00:21:32,46 a laser on that person because we thought it was covered those things that are part 288 00:21:32,47 --> 00:21:36,26 of the laser they were covered by going going back to the laser for just brief and 289 00:21:36,27 --> 00:21:38,98 I know we don't cover. Do we have 290 00:21:38,99 --> 00:21:42,98 a Do we have an appeal process for that or we're just at the what they say the 291 00:21:42,99 --> 00:21:47,56 person's lasered thats it. Correct that's part of the UNDER A Because we can choose 292 00:21:47,57 --> 00:21:51,63 not to go with them we go to we go from company to company B. X. 293 00:21:51,64 --> 00:21:56,99 Was the company might have two losers the next we might have one and it's always 294 00:21:57,00 --> 00:22:01,45 really well worth it to evaluate and we do each year we'll say OK what's the 295 00:22:01,49 --> 00:22:05,53 likelihood that this is going to happen this individual because again if you can 296 00:22:05,54 --> 00:22:09,79 get a conditional laser reality is you get rid of lasers OK but there's 297 00:22:09,80 --> 00:22:14,15 a cost so they're not nonprofit organization right so if you think they think 298 00:22:14,16 --> 00:22:16,49 they're going to pay that hundred twenty five you're to pay an extra fifteen 299 00:22:16,50 --> 00:22:19,06 premium or an extra forty and OK there might be a little bit of 300 00:22:19,07 --> 00:22:23,44 a break even so if we really think that it's not likely and it really we have 301 00:22:23,45 --> 00:22:27,39 underwriters for this and our staff and team so that people are looking at this 302 00:22:27,40 --> 00:22:31,75 pretty good with some nurses saying is this really going to happen and then we 303 00:22:31,76 --> 00:22:33,93 evaluate whether we take the laser or we pay 304 00:22:33,94 --> 00:22:38,55 a little extra premium and somebody has written yes long we think you really have 305 00:22:38,56 --> 00:22:42,91 to order to read We're going to want to pay it so the next issue is how do we 306 00:22:42,92 --> 00:22:45,74 compare with other public and private employers we've got 307 00:22:45,75 --> 00:22:50,11 a whole service with lots of data that I'll just give it to you to take home with 308 00:22:50,12 --> 00:22:51,56 you we took 309 00:22:51,57 --> 00:22:57,12 a look at things like employee versus employee contributions plan design including 310 00:22:57,13 --> 00:23:02,22 self insured other lines of coverage offered and these are some of the communities 311 00:23:02,23 --> 00:23:07,72 that we looked at these are the the cities that we there are comps for for 312 00:23:07,87 --> 00:23:13,08 historical purposes and we did three other local private employers as well so what 313 00:23:13,09 --> 00:23:18,24 we find so we have about ten respondents including us so ten out of the survey 314 00:23:18,68 --> 00:23:23,64 seven of the nine have self funded medical plans the larger cities typically do 315 00:23:23,94 --> 00:23:29,07 because they can manage some of that themselves I know the county has gone back and 316 00:23:29,08 --> 00:23:32,72 forth between self insured fully insured and they're leaning towards going back to 317 00:23:32,73 --> 00:23:35,35 self insured for the same reasons that 318 00:23:35,36 --> 00:23:40,71 a large A lot of these larger employers do eight out of the ten offer more than one 319 00:23:40,72 --> 00:23:44,69 medical plan we're not one of them we we technically have more than one medical 320 00:23:44,70 --> 00:23:49,53 plan. But that's really just for transit because of our union negotiations five out 321 00:23:49,54 --> 00:23:54,44 of the ten offer three or more medical plans so a lot of times that is is offering 322 00:23:54,45 --> 00:23:59,10 a higher deductible lower premium type of thing you can do those types of things. 323 00:24:00,51 --> 00:24:04,73 For out of the ten respondents offer health savings account three out of nine offer 324 00:24:04,74 --> 00:24:09,96 health reimbursement those if one didn't respond we showed them and those are some 325 00:24:09,97 --> 00:24:13,82 of the things we looked at Additionally wellness is 326 00:24:13,83 --> 00:24:19,64 a big issue five them are standalone programs that bill use and the definition of 327 00:24:19,65 --> 00:24:21,86 wellness we're going to get a little more into that 328 00:24:21,87 --> 00:24:27,47 a little bit later but biometric screenings are things that we take 329 00:24:27,48 --> 00:24:33,74 a look at statistics about our our group. And we it's based on these screenings 330 00:24:33,75 --> 00:24:39,17 that we do blood draws things like that. And it helps us understand what our 331 00:24:39,30 --> 00:24:44,40 workforce will looks like but we currently only do screenings for our employees we 332 00:24:44,41 --> 00:24:48,96 do not do them for dependents I think we we allow it but we we don't require it 333 00:24:49,25 --> 00:24:55,95 there's no reason that we offer it right now. Only one respondent offers employer 334 00:24:55,96 --> 00:24:59,18 contributions to wellness activities through the H.R.A. 335 00:24:59,18 --> 00:25:02,98 . One responder offers 336 00:25:02,99 --> 00:25:06,94 a contribution differential based on tobacco use eight or nine are in the process 337 00:25:06,95 --> 00:25:10,95 of looking some other type of differential for 338 00:25:10,96 --> 00:25:13,93 a cherry biometric screening which means there take 339 00:25:13,94 --> 00:25:20,85 a look at the how healthy the group is and basing rates on that as 340 00:25:20,86 --> 00:25:24,35 well the only we do offer discount right now we'll get into that 341 00:25:24,36 --> 00:25:28,63 a little later but it's only on taking the health risk assessment. 342 00:25:31,38 --> 00:25:35,35 Ninety nine are still eligible to participate and help plan if they don't do the H 343 00:25:35,36 --> 00:25:37,86 R eight bet includes us we just have 344 00:25:37,87 --> 00:25:44,78 a premium if you don't take the health risk assessment. For other four out of the 345 00:25:44,79 --> 00:25:50,70 to. Then offer an employee plus one and I want to just briefly tell you about 346 00:25:50,71 --> 00:25:55,80 employee plus one there's a lot of assumptions that employee plus one means like 347 00:25:55,81 --> 00:25:56,63 a single parent and 348 00:25:56,64 --> 00:26:03,48 a kid and that's true that doesn't clue that but that is not the correct stereotype 349 00:26:03,96 --> 00:26:09,87 it really is more of the empty nesters it's not an employee plus one child it's an 350 00:26:09,88 --> 00:26:14,16 employee and another spouse and that's when I talked about that the kitchen table 351 00:26:14,17 --> 00:26:20,76 conversation you know empty nesters both working they pick one or the other. So 352 00:26:21,50 --> 00:26:25,45 only four out of the ten offer employee plus one plan Mark your statistics are 353 00:26:25,49 --> 00:26:28,96 three hundred eighty we have three hundred eighty nine spouses on the plan and ten 354 00:26:28,97 --> 00:26:34,91 single parents so there goes that means it's not what you think it is most people 355 00:26:34,92 --> 00:26:40,21 think it's single parents it isn't not at all. Four out of the ten offer 356 00:26:40,22 --> 00:26:45,85 a post sixty five retiree plan all seven cities it did respond to this question 357 00:26:46,39 --> 00:26:52,44 have pretty sick five retirees so that means early retirees they cover. See it see 358 00:26:52,45 --> 00:26:56,19 some of those things. All the other respondents have 359 00:26:56,20 --> 00:26:59,40 a dental plan I'm just pointing it out because we do not have 360 00:26:59,41 --> 00:27:04,65 a dental plan and so while in some cases we may offer some other things that 361 00:27:04,66 --> 00:27:10,46 employees employees do get here they don't get dental they are just just in full 362 00:27:10,47 --> 00:27:11,83 disclosure that's 363 00:27:11,87 --> 00:27:19,04 a weakness in our play compared to others. It's 364 00:27:19,05 --> 00:27:25,45 far. More. Voluntary you want to you want in the plane you're welcome to 365 00:27:25,46 --> 00:27:30,55 a picture of your pay in the full full boat so that there are three drivers correct 366 00:27:30,63 --> 00:27:32,03 very good point and even 367 00:27:32,30 --> 00:27:37,50 a structural discomfort and even the employer paid is probably partially paid I 368 00:27:37,51 --> 00:27:42,23 think it depends on the plane you get very good point. They have to talk about 369 00:27:42,24 --> 00:27:46,56 where some of the market trends are. With market trends these are things that are 370 00:27:46,57 --> 00:27:50,84 just happening out there whether it's due to affordable care act or it's just 371 00:27:50,85 --> 00:27:56,03 employers in general trying to manage their costs but what I want to talk mostly 372 00:27:56,04 --> 00:27:59,02 about is how this is going to affect the city and some of the decision points that 373 00:27:59,03 --> 00:28:00,05 we may be making 374 00:28:00,39 --> 00:28:03,86 a little bit later on as we kind of look at what our challenges and opportunities 375 00:28:03,87 --> 00:28:07,54 are going to be so we already mentioned and Mark mentioned the dual plan tear 376 00:28:07,89 --> 00:28:11,85 basically the new theory about dual plans and this is 377 00:28:11,86 --> 00:28:16,20 a complete antithesis of how most people think not only do most people think that 378 00:28:16,21 --> 00:28:17,03 it's just me and 379 00:28:17,04 --> 00:28:21,17 a kid which it isn't and we kind of saw that on your health plans to test X. 380 00:28:21,34 --> 00:28:26,14 But a lot of people also think that me and my spouse I have got to be cheaper than 381 00:28:26,15 --> 00:28:29,64 a young family with three or four little kids well I'll tell you what I think about 382 00:28:29,65 --> 00:28:34,12 that statistically if me and my fifty year old husband because we're both at fifty 383 00:28:34,25 --> 00:28:38,22 are just doing wellness stuff I call and ask obese are five thousand dollars apiece 384 00:28:38,23 --> 00:28:42,60 before discounting our blood work is different my husband is a prostate and it's 385 00:28:42,61 --> 00:28:46,79 a test I need pap smears I need mammograms I'll take two thirty year olds with 386 00:28:46,80 --> 00:28:50,01 three little kids any time because they're getting their Nina act in their ears 387 00:28:50,02 --> 00:28:53,87 listen to what they're probably having one hundred dollars. You know for 388 00:28:53,88 --> 00:28:57,39 a wellness check up and we're having five to ten thousand depending upon what we're 389 00:28:57,40 --> 00:29:02,59 having taken care of so when you look at the health plans to to Stickley. The 390 00:29:02,60 --> 00:29:06,16 reality is is that two fifty year olds which is 391 00:29:06,20 --> 00:29:10,55 a big part of your plan are going to be always higher costs so if you were going to 392 00:29:10,56 --> 00:29:15,30 do this logically and actuarily you'd actually charge the employee plus false more 393 00:29:15,31 --> 00:29:19,08 than you would charge the full family instead what happens is you can tell an 394 00:29:19,09 --> 00:29:23,60 underwriter to carve out your rates as many ways as you want or however you want so 395 00:29:23,61 --> 00:29:26,51 the reality is that the end of the day if I need ten million dollars to run your 396 00:29:26,52 --> 00:29:30,65 health plan I'll carve up to employ plus spouse employer plus children and full 397 00:29:30,66 --> 00:29:34,26 family but the full families are going to pay more to subsidize those middle tears 398 00:29:34,27 --> 00:29:38,09 if you want them to be paying less it's just the way it works and as we 399 00:29:38,10 --> 00:29:42,73 statistically start to float to more dual plan choices the reality is we're 400 00:29:42,74 --> 00:29:46,86 burdening those costs on some of our younger folks and then they're making 401 00:29:46,87 --> 00:29:50,58 different decisions around the kitchen table the other reason to talk about the 402 00:29:50,59 --> 00:29:56,27 dual plan tears most of the private sector employers are looking at doing 403 00:29:56,28 --> 00:30:00,18 a couple different things with spouses they're looking at special carve outs which 404 00:30:00,19 --> 00:30:03,90 are saying if your spouse is eligible for health coverage where they work they 405 00:30:03,91 --> 00:30:09,52 can't be on this planet all. Now I'm not suggesting that the city does that but the 406 00:30:09,53 --> 00:30:12,95 reality is if every private sector employers doing it you're going to end up with 407 00:30:12,96 --> 00:30:16,91 more of those employed plus false is back on your plan just an obvious choice goes 408 00:30:16,92 --> 00:30:20,24 back to the kitchen table discussion if you and your spouse are talking about it 409 00:30:20,60 --> 00:30:24,84 and one ploy or is going to pay for the house the other one says you got to go 410 00:30:24,85 --> 00:30:29,75 separate Well then you're naturally going to go to the employer that pays both of 411 00:30:29,76 --> 00:30:33,95 them that will cover both of them as opposed to paying for two separate plans 412 00:30:34,74 --> 00:30:39,11 that's. We're going to it's you know we talk about adverse selection where people 413 00:30:39,12 --> 00:30:39,72 go away from 414 00:30:39,73 --> 00:30:45,25 a plan this is this is adverse selection into our plan and they're the they're the 415 00:30:45,26 --> 00:30:51,59 fifty's and older group it's not the employee plus one child so we're getting 416 00:30:52,40 --> 00:30:56,91 we're getting more expensive cost because of that well and you think about just 417 00:30:56,92 --> 00:31:00,06 even the economy where people are losing jobs it's typically 418 00:31:00,07 --> 00:31:03,09 a little bit sometimes the older workers so they might. Becoming back on your plan 419 00:31:03,10 --> 00:31:04,10 so it's it's just 420 00:31:04,11 --> 00:31:07,14 a decision point that we have to be aware of because our plan is going to have to 421 00:31:07,15 --> 00:31:11,89 respond to it the other way to handle spouses this fossil surcharges this hits 422 00:31:11,93 --> 00:31:16,42 every spalls equally you have a spouse on the plan you pay more. It's just 423 00:31:16,46 --> 00:31:20,88 a reality the Affordable Care Act By the way specifically says that employers do 424 00:31:20,89 --> 00:31:25,41 not have to provide coverage to spouses at all for any reason because now they can 425 00:31:25,42 --> 00:31:28,10 go to the exchange so they have a landing it may not be 426 00:31:28,11 --> 00:31:30,92 a soft landing that they would have liked but they have a landing so 427 00:31:31,24 --> 00:31:34,65 a lot of plans in the private sector particularly smaller employers are saying 428 00:31:34,66 --> 00:31:37,51 we're just not if spouses around are going to pay MORE hundred dollars more 429 00:31:37,52 --> 00:31:38,81 a month fifty dollars more 430 00:31:38,82 --> 00:31:42,86 a month something along those lines just to be on our health plan the reason that I 431 00:31:42,87 --> 00:31:43,19 spent 432 00:31:43,20 --> 00:31:46,84 a little bit of time on that is because of the other thing that's coming down the 433 00:31:46,85 --> 00:31:50,88 pike we have a Wisconsin Supreme Court that's deciding right now as well as 434 00:31:50,89 --> 00:31:55,18 a federal court deciding whether our constitutional ban against same sex marriage 435 00:31:55,19 --> 00:32:00,50 is constitutional here in the state of Wisconsin So if the courts decide that we 436 00:32:00,51 --> 00:32:05,02 need to put domestic partners on our plan and we don't have special surcharges 437 00:32:05,03 --> 00:32:08,24 we're actually or we do we had spousal surcharges we're actually creating 438 00:32:08,25 --> 00:32:13,83 a newly eligible class for partners where spouses would be excluded so we just need 439 00:32:13,84 --> 00:32:19,00 to stay on top of this we're watching it very closely for the city but there's more 440 00:32:19,01 --> 00:32:19,08 of 441 00:32:19,09 --> 00:32:23,90 a discussion here than just isn't the right thing to do with their tax consequences 442 00:32:23,91 --> 00:32:28,16 because they're not married the way the state would look at marriage so there's tax 443 00:32:28,17 --> 00:32:30,13 consequences what do you do with the kids 444 00:32:30,45 --> 00:32:34,69 a couple of the technical colleges have allowed the partner but not their children 445 00:32:35,61 --> 00:32:40,46 Wisconsin does not allow for dual adoption so if the children of 446 00:32:40,47 --> 00:32:45,02 a domestic partnership belong to the partner and not the employee and the 447 00:32:45,03 --> 00:32:48,99 partnership is dissolved the kids don't get COBRA so they're literally off the plan 448 00:32:49,00 --> 00:32:52,97 the day the partnership is dissolved with no ability to stay on the plan so 449 00:32:52,98 --> 00:32:57,87 a lot of just different weird little things going on with dependent eligibility 450 00:32:58,15 --> 00:33:03,46 that we should be cognizant of and we need if we're When that those decisions come 451 00:33:03,47 --> 00:33:05,87 down which we will likely not be 452 00:33:06,47 --> 00:33:11,08 a direct party to will be indirectly impacted if we get our spousal benefits. 453 00:33:12,12 --> 00:33:13,89 Policies are ducks in 454 00:33:13,90 --> 00:33:19,32 a row on that then when it happens we can respond appropriately in quickly rather 455 00:33:19,33 --> 00:33:22,61 than reacting to something so that's probably 456 00:33:22,65 --> 00:33:29,06 a big takeaway from today's. It's in general. So that. 457 00:33:30,42 --> 00:33:35,38 The last two we have early retiree benefits as I mentioned as we mentioned in the 458 00:33:35,39 --> 00:33:38,86 survey and you're going to see this when you read the results even the parties that 459 00:33:38,87 --> 00:33:42,27 have them all of the cities six out of seven respondents are saying they're trying 460 00:33:42,28 --> 00:33:45,67 to buy these out they are trying to get rid of them they're trying to do retiree 461 00:33:45,68 --> 00:33:48,22 only health reimbursement accounts where you can put in 462 00:33:48,87 --> 00:33:53,31 a large deposit on an annual basis so that when the retiree leaves your plan they 463 00:33:53,32 --> 00:33:57,51 get COBRA and then they've got to go find something for themselves so almost 464 00:33:57,55 --> 00:34:01,98 everyone is saying we can't afford this other post employment benefit liability 465 00:34:02,40 --> 00:34:07,24 it's really starting to hurt our budget Terry spreadsheets and our in our balance 466 00:34:07,25 --> 00:34:11,79 sheets we have to look at this so cities are and colonies municipal governments 467 00:34:11,80 --> 00:34:15,96 quite frankly are the only ones that are still doing this cities are unique and 468 00:34:15,97 --> 00:34:17,43 you're you are unique because 469 00:34:17,47 --> 00:34:21,81 a majority of your population typically fifty to sixty percent are police and fire 470 00:34:22,05 --> 00:34:26,14 they legitimately can't do their job sometimes tell sixty five so you're going to 471 00:34:26,15 --> 00:34:30,33 have an early retirement where it may be appropriate from 472 00:34:30,34 --> 00:34:34,51 a workforce development situation but not necessarily looking good on your 473 00:34:34,52 --> 00:34:39,23 spreadsheet So again something to be aware of how many retirees do we have on 474 00:34:39,24 --> 00:34:46,24 average approximately per year. Yeah. Fifty currently that's ten percent the only 475 00:34:46,25 --> 00:34:49,30 reason I ask is because typically the conversations that I have with people that 476 00:34:49,31 --> 00:34:55,10 either just retired or are looking to retire is to Reanna spry and they literally 477 00:34:55,11 --> 00:35:00,90 will go and have any test anything done the last six months of employment. 478 00:35:02,09 --> 00:35:03,08 Before they're out and that's just 479 00:35:03,09 --> 00:35:06,53 a real challenge with our costs demographically the last few years too we've had 480 00:35:06,54 --> 00:35:10,58 retirements based on polls that tend when but bargaining agreements are going to 481 00:35:10,59 --> 00:35:14,75 come up three but the. We tarried everything for premium All right citizen pay 482 00:35:14,76 --> 00:35:19,65 a portion of that right but if but think about your own mindset if I was going to 483 00:35:19,66 --> 00:35:21,83 pay roughly two thousand dollars a month for 484 00:35:21,84 --> 00:35:24,10 a family plan why am I going to do that I know I'm getting 485 00:35:24,11 --> 00:35:26,29 a value out of it it's not usually just for 486 00:35:26,30 --> 00:35:29,96 a safety net or protection anymore if I'm really truly healthy I'm going to look 487 00:35:29,97 --> 00:35:31,54 for private insurance that cost me 488 00:35:31,55 --> 00:35:36,57 a lot less so we're getting adversely selected against by having those retirees on 489 00:35:36,58 --> 00:35:39,18 the plan even paying full premium they know they're getting 490 00:35:39,19 --> 00:35:44,62 a value out of it we are all good consumers. Right but we're not in 491 00:35:44,63 --> 00:35:45,68 a lot of times it's 492 00:35:45,69 --> 00:35:50,76 a safety net I had something go on or I'm you know in our our age group and I say 493 00:35:50,77 --> 00:35:55,48 ours collectively and some of you are younger so I apologize but we're very much 494 00:35:55,53 --> 00:36:01,42 about it's why we sign up for Obamacare. We think you have to have insurance we're 495 00:36:01,43 --> 00:36:05,22 a lot more cognizant about stuff like that than our twenty five year old kids but 496 00:36:05,23 --> 00:36:08,28 the reality is we also know we're going to get something out of it or we wouldn't 497 00:36:08,29 --> 00:36:10,20 do it and we certainly won't do it if we had 498 00:36:10,21 --> 00:36:12,74 a nother place to go comparatively speaking of 499 00:36:12,96 --> 00:36:15,46 a full I mean it's slightly under two thousand 500 00:36:15,47 --> 00:36:19,74 a month for full family plan if you take that out that's twenty four thousand 501 00:36:19,75 --> 00:36:24,03 a year. Are you going to get more than twenty four thousand dollars worth of health 502 00:36:24,04 --> 00:36:25,91 care you get a call and ask a P. 503 00:36:25,92 --> 00:36:31,32 And in some other medical procedure you're you're halfway there those knees those 504 00:36:31,33 --> 00:36:38,22 new knees those new hips you know to your point. And that's B. 505 00:36:38,23 --> 00:36:42,08 I think you're right on in terms of some of the additional costs that we just 506 00:36:42,14 --> 00:36:44,27 realized recently you know we talked about 507 00:36:44,28 --> 00:36:49,55 a lot of those five cost lawsuits that were really on our radar screen in terms of 508 00:36:49,56 --> 00:36:55,95 reporting that we look for and we really had Sun abolished early retirement with or 509 00:36:56,89 --> 00:37:01,45 early people in and I think it was one of the things that we that was on for seem 510 00:37:01,94 --> 00:37:08,90 to support were looking at it in the context of. Concision plan itself but. Maybe 511 00:37:08,91 --> 00:37:10,47 forgot about the idea that do 512 00:37:10,51 --> 00:37:16,40 a lot of people do get their body parts fixed before the you know for sure it is OK 513 00:37:16,41 --> 00:37:22,73 answer the question George for him. But this was not 514 00:37:22,74 --> 00:37:27,65 a surprise that he would throw no. It's an excellent point that's kind of an 515 00:37:27,66 --> 00:37:34,51 unforseen thing. Well and to that same logic there goal part timers 516 00:37:35,13 --> 00:37:38,29 now that the Affordable Care Act has set full time a thirty hours 517 00:37:38,30 --> 00:37:43,89 a week anybody below that we have people here for example I believe the library 518 00:37:43,90 --> 00:37:46,92 contract still says seven hundred twenty hours a year that gives you 519 00:37:46,93 --> 00:37:51,28 a lot of time to go get health care. You know so and I'm not picking on them but 520 00:37:51,29 --> 00:37:53,64 part timers typically somebody works for 521 00:37:53,65 --> 00:37:57,76 a municipal government because maybe their spouse is self employed or they have 522 00:37:57,77 --> 00:38:01,44 a family farm or they're doing something else where there is not workers' comp 523 00:38:01,45 --> 00:38:02,66 insurance and so we have 524 00:38:02,67 --> 00:38:08,36 a lot of additional risk with these two groups no public no private sector employer 525 00:38:08,37 --> 00:38:12,12 anymore is offering coverage to part timers even if they pay the entire freight or 526 00:38:12,13 --> 00:38:14,06 some portion thereof so this is 527 00:38:14,07 --> 00:38:19,91 a huge benefit that psychologically the city gives to people I'm not again 528 00:38:19,92 --> 00:38:22,30 advocating one hundred percent that you change it in 529 00:38:22,31 --> 00:38:26,94 a flash but it is something we need to be aware of because no one else is doing it 530 00:38:27,35 --> 00:38:33,54 you may be getting people coming to look for work here for the benefits and not 531 00:38:33,55 --> 00:38:39,81 necessarily for the work so it's just something to be cognizant of. Now you see 532 00:38:39,82 --> 00:38:44,46 a I'm going to go through this pretty quickly for anybody that wants to spend any 533 00:38:44,47 --> 00:38:48,96 time with me afterwards we can talk about tell probably the cows come home but 534 00:38:49,58 --> 00:38:49,76 there's 535 00:38:49,77 --> 00:38:52,75 a couple things that I think are important the pair play this is the employer 536 00:38:52,76 --> 00:38:54,70 mandate in fact I was just telling 537 00:38:54,71 --> 00:38:59,51 a consummate Berk that they just changed the penalties which no employer has been 538 00:38:59,52 --> 00:39:02,96 responsible to pay yet so they just went up four point four percent so that two 539 00:39:02,97 --> 00:39:06,23 thousand dollars is now two thousand and eighty four and the three thousand dollars 540 00:39:06,24 --> 00:39:09,04 penalty we're going to be talking about is three thousand one hundred twenty eight 541 00:39:09,19 --> 00:39:12,53 and no one's paid yet they're not even do tell twenty sixteen so they're already 542 00:39:12,54 --> 00:39:16,39 increasing penalties and something that nobody's paying so they know they're not 543 00:39:16,40 --> 00:39:19,75 getting enough but they don't they're not sure what enough is going to be we 544 00:39:19,76 --> 00:39:23,96 basically have to offer coverage to seventy percent of all full time employees and 545 00:39:23,97 --> 00:39:27,42 we have to offer coverage or pay the penalty so this is where people say I'm going 546 00:39:27,43 --> 00:39:30,17 to get out of the health insurance business I pay that two thousand dollars on 547 00:39:30,18 --> 00:39:32,02 every employer it changes to 548 00:39:32,03 --> 00:39:35,98 a ninety five percent threshold in two thousand and sixteen failure to offer 549 00:39:35,99 --> 00:39:41,48 appropriately or the decision not to offer get you the same penalty so if you don't 550 00:39:41,49 --> 00:39:45,38 offer to ninety five percent in two thousand and sixteen of the eligible full time 551 00:39:45,39 --> 00:39:48,73 employees according to the Affordable Care Act you get that same two thousand and 552 00:39:48,74 --> 00:39:52,96 eighty four dollars penalty for each person regardless of whether you offered it to 553 00:39:53,05 --> 00:39:57,39 ninety percent you can't miss on the five The city does pass this test we we 554 00:39:57,40 --> 00:40:01,69 monitor this all of the time so even when we thought it was going to be ninety five 555 00:40:01,80 --> 00:40:06,49 we knew we were making it so the city does offer very very well the affordability 556 00:40:06,50 --> 00:40:11,09 provision this is the three thousand dollars per per person who doesn't pass the 557 00:40:11,10 --> 00:40:16,36 test penalty if you test the employee contribution so the employee portion of the 558 00:40:16,37 --> 00:40:22,94 premium of the lowest paid employee against the lowest attribution 559 00:40:23,25 --> 00:40:26,33 single plan is the threshold so the A.C.L.U. 560 00:40:26,34 --> 00:40:29,61 Does not mandate coverage for the spouses which is why we contest to the single 561 00:40:29,62 --> 00:40:33,36 plan employee contribution Marts going to take you through the test because this is 562 00:40:33,37 --> 00:40:38,27 an actual city example this is how it applies to us right. So taking thirty hours 563 00:40:38,28 --> 00:40:39,49 which is one hundred thirty hours 564 00:40:39,50 --> 00:40:43,18 a month the lowest paid eligible employee currently makes ten dollars ninety cents 565 00:40:43,19 --> 00:40:47,57 an hour or fourteen hundred plus per month ninety nine percent of that hundred 566 00:40:47,58 --> 00:40:48,33 thirty four dollars 567 00:40:48,34 --> 00:40:53,02 a month the current employee single premium contributions one hundred one so we're 568 00:40:53,03 --> 00:40:57,55 under that we're OK We don't have seen that one thirty four The reason I point this 569 00:40:57,56 --> 00:41:01,35 out is if we're over the threshold the employee eligible for subsidy in 570 00:41:01,36 --> 00:41:07,21 participation on the federal exchange city be penalized even though well under. Our 571 00:41:07,27 --> 00:41:11,84 current contribution is twelve percent if we just for the sake of discussion point 572 00:41:12,03 --> 00:41:17,67 took that to sixteen percent. Premium contribution that would take us over that 573 00:41:17,68 --> 00:41:22,42 threshold because suddenly we would go because that's twelve to sixteen percent is 574 00:41:22,43 --> 00:41:23,65 not four percent that's 575 00:41:23,66 --> 00:41:27,20 a thirty three percent increase so you'd be looking at one hundred thirty four 576 00:41:27,21 --> 00:41:31,31 dollars you'd be knocking down that door or exceeding it so now there's games you 577 00:41:31,32 --> 00:41:35,34 can play to get around you can you just there be some part time versus phone call 578 00:41:35,35 --> 00:41:39,58 we got to do is say our time relays are hours you're thirty hours we're going to 579 00:41:39,59 --> 00:41:40,55 get you to twenty five hours 580 00:41:40,56 --> 00:41:44,73 a week then you don't meet that standard So there's ways to get around it but the 581 00:41:44,74 --> 00:41:50,80 point I want to make here is that we can't simply keep raising the premium charge 582 00:41:50,81 --> 00:41:55,17 because there's always going to be that thing haunting us in the background that we 583 00:41:55,18 --> 00:41:59,59 have to be cognizant of you have to look for other ways to manage the cost you to 584 00:41:59,60 --> 00:42:01,85 so you're saying even a part time employee at thirty hours 585 00:42:01,86 --> 00:42:06,26 a week if we want if we said keep them at all percent but full time employees are 586 00:42:06,27 --> 00:42:10,56 going to be sixty percent you can't do that yet we could because he would still 587 00:42:10,57 --> 00:42:16,48 stay at then Rush told the threshold is that lowest paid employee single point so 588 00:42:16,49 --> 00:42:20,54 you get these him towards the others right OK And remember you don't get to say 589 00:42:20,55 --> 00:42:23,54 what's full time and part time anymore the Affordable Care Act has decided that 590 00:42:23,55 --> 00:42:24,47 full time is thirty hours 591 00:42:24,48 --> 00:42:30,18 a week. How did you what is your your thirty hours week we just say we're cutting 592 00:42:30,19 --> 00:42:33,83 you to twenty five hours and now you're no longer eligible for health insurance and 593 00:42:33,84 --> 00:42:37,21 I think you're out of the moronic. Trap 594 00:42:37,22 --> 00:42:40,95 a thing to remember is they did the purpose the Affordable Care Act is to try to 595 00:42:40,96 --> 00:42:42,00 provide insurance for 596 00:42:42,27 --> 00:42:47,21 a large group of folks so. Bran talked about some of the modifications that are 597 00:42:47,32 --> 00:42:53,25 taking place they know that employers are trying to make those changes just because 598 00:42:53,26 --> 00:42:56,48 they're trying to make sure that they can afford to continue to stay in business 599 00:42:56,49 --> 00:43:00,56 but those modifications are going to continue to be adjusted as 600 00:43:00,57 --> 00:43:05,71 a relates to that kind of an adjustment to. Because that's the purpose for. 601 00:43:07,71 --> 00:43:08,43 Three I'm going to talk 602 00:43:08,44 --> 00:43:13,79 a little bit about some of the exchange and how they were impacted by the one thing 603 00:43:13,80 --> 00:43:15,37 to remember and we've started to do 604 00:43:15,38 --> 00:43:19,09 a lot of employers education sessions and various municipalities and school 605 00:43:19,10 --> 00:43:22,69 districts because one of the things that employees very often don't understand is 606 00:43:22,99 --> 00:43:28,78 if the city offers an affordable plan that meets all the thresholds we offer 607 00:43:28,79 --> 00:43:32,48 correctly it's affordable and it meets the minimum essential benefit requirements 608 00:43:32,49 --> 00:43:35,04 which I'm going to talk about in a second they're not eligible for 609 00:43:35,05 --> 00:43:39,03 a subsidy no matter what their what's going on in their household so we have we 610 00:43:39,04 --> 00:43:39,58 literally have 611 00:43:39,59 --> 00:43:43,77 a situation where there's not necessarily free health care even in the exchange 612 00:43:43,78 --> 00:43:45,35 unless we screw something up or they have 613 00:43:45,36 --> 00:43:50,03 a really different or difficult home situation the single parent with five or six 614 00:43:50,04 --> 00:43:54,21 little kids I don't get child support something along those lines so we want to let 615 00:43:54,22 --> 00:43:58,79 people know what to the extent the state exchange plans look like the bronze plan 616 00:43:58,80 --> 00:44:00,56 which is the threshold for the balance is 617 00:44:00,57 --> 00:44:04,93 a two thousand dollars single deductible four thousand dollars family sixty forty 618 00:44:04,94 --> 00:44:09,22 percent coverage and network no prescription drugs other than generic so it looks 619 00:44:09,23 --> 00:44:11,00 very much like a Medicare Part D. 620 00:44:11,01 --> 00:44:17,73 Prescription drug plan that plan for me my husband and my son with after 621 00:44:17,74 --> 00:44:20,10 tax dollars is over twenty two thousand dollars 622 00:44:20,11 --> 00:44:26,52 a year and it's after tax that's the bronze plan so the federal And so as you go up 623 00:44:26,63 --> 00:44:31,49 silver gold platinum you just get seventy percent eighty percent ninety percent 624 00:44:31,50 --> 00:44:33,13 there are no one hundred percent plans 625 00:44:33,25 --> 00:44:36,75 a few more drugs so it's it's not necessarily even 626 00:44:36,76 --> 00:44:42,08 a who's my doctor situation here in Wisconsin it's what plan can I afford to buy 627 00:44:42,40 --> 00:44:47,11 and what drugs do I need within my within my world so it's just an interesting way 628 00:44:47,12 --> 00:44:52,49 to look at health care from what is even offered so it doesn't look like Medicaid 629 00:44:52,50 --> 00:44:54,10 it doesn't look like Medicare it's 630 00:44:54,11 --> 00:44:58,67 a very different threshold and it's important minimum essential benefits the state 631 00:44:58,68 --> 00:45:02,29 of Wisconsin is probably the second toughest insurance state in the U.S. 632 00:45:02,64 --> 00:45:06,90 We have four. Eight different mandates and the city has to cover each and every one 633 00:45:06,91 --> 00:45:10,33 of those things so it can be something as simple as chiropractic has to be covered 634 00:45:10,33 --> 00:45:13,58 . Here in the state of Wisconsin I'm 635 00:45:13,59 --> 00:45:17,44 a private sector employer and I'm self funded like you guys are I can actually 636 00:45:17,45 --> 00:45:21,03 select my state so maybe I want to be status in Utah where they have four state 637 00:45:21,04 --> 00:45:25,78 mandates cities can't really do that so we're kind of stuck with what Wisconsin 638 00:45:25,79 --> 00:45:31,85 mandates that we offer and we as an insurance state will say nonfederal is self 639 00:45:31,86 --> 00:45:36,43 funded governmental entities have to cover like fully insured carriers do so we 640 00:45:36,44 --> 00:45:40,83 don't get away with some of the same things again the city passes the minimum 641 00:45:40,84 --> 00:45:44,94 essential benefits test we meet our actual aerial values we meet reasonable care 642 00:45:44,95 --> 00:45:48,49 standards under the Affordable Care Act there's no way the city will get 643 00:45:48,53 --> 00:45:50,89 a penalty now we also have 644 00:45:50,93 --> 00:45:55,32 a new requirement starting this year next year it includes prescription drug 645 00:45:55,33 --> 00:46:00,36 co-payments in network everything counts against A maximum out of pocket so my 646 00:46:00,37 --> 00:46:05,09 deductibles my co-payments my co-insurance if I have them everything other than 647 00:46:05,10 --> 00:46:06,40 a penalty has to count to 648 00:46:06,41 --> 00:46:10,39 a maximum out of pocket you can only charge employees minus their premium 649 00:46:10,40 --> 00:46:13,15 contribution sixty three hundred dollars 650 00:46:13,19 --> 00:46:17,09 a single and twelve thousand seven hundred dollars a family so if you have 651 00:46:17,13 --> 00:46:20,42 a couple of kids for example that are huge as Manics or get 652 00:46:20,43 --> 00:46:23,30 a lot of your infections and they're going to the doctor going to the doctor 653 00:46:23,51 --> 00:46:24,00 they're going to have 654 00:46:24,01 --> 00:46:27,66 a maximum out of pocket. It's called I'm sure to be hearing about 655 00:46:27,67 --> 00:46:34,19 a few of those things. And then there's the practical out of pocket you can make up 656 00:46:34,20 --> 00:46:41,17 your own energy. You can't simply result despite crease in the 657 00:46:41,18 --> 00:46:44,74 deductibles because essentially you're going to hit those writings walls as well so 658 00:46:45,02 --> 00:46:49,54 that's the the new world that we're dealing with and the other part we want to 659 00:46:49,55 --> 00:46:52,69 remind everybody about is where we are with collective bargaining agreements the 660 00:46:52,70 --> 00:46:59,01 post fact ten and thirty two World Police and fire still negotiate for premium 661 00:46:59,02 --> 00:47:04,34 contribution they don't they are unable to negotiate at this time features of the 662 00:47:04,35 --> 00:47:08,38 plant so we can change plan features that's still going through the court system 663 00:47:08,39 --> 00:47:12,69 that could get changed we believe the interpretation is going to remain that we can 664 00:47:12,70 --> 00:47:16,93 dictate what the plan will be the only thing we can negotiate is the premium share 665 00:47:17,46 --> 00:47:20,71 but stay tuned for that that's that's still out there and just 666 00:47:20,72 --> 00:47:25,16 a reminder that because transit workers were excluded from X. 667 00:47:25,17 --> 00:47:28,25 Ten and thirty two we technically have 668 00:47:28,26 --> 00:47:32,22 a separate plan for them because they did not want to go to the plan that the 669 00:47:32,23 --> 00:47:36,55 council approved and we had no say in the matter it was part of our agreement so 670 00:47:36,73 --> 00:47:42,45 until we renegotiate that contract which we will be doing this year. We're 671 00:47:43,42 --> 00:47:44,51 we're very very in 672 00:47:44,52 --> 00:47:49,23 a separate plan and we still have to negotiate with them and they may or may not be 673 00:47:49,24 --> 00:47:53,43 lined up with all the other employees in their group and oftentimes you know when 674 00:47:53,44 --> 00:47:54,24 we were talking about 675 00:47:54,25 --> 00:47:58,56 a comparison to some of the other municipalities will see them have three and four 676 00:47:58,57 --> 00:48:01,48 plans sometimes those are relics of 677 00:48:01,72 --> 00:48:04,88 a situation like this where they might have just 678 00:48:04,89 --> 00:48:09,28 a small group of employees in those employees were getting access to that plan 679 00:48:09,60 --> 00:48:10,65 during the days when they had 680 00:48:10,66 --> 00:48:15,86 a collective bargaining agreement. Some of the municipalities are transitioning to 681 00:48:15,86 --> 00:48:21,58 . Less plans as a result of that but this is an example of that on 682 00:48:21,59 --> 00:48:27,04 a smaller scale really have two plans transit has their own plan because of the boy 683 00:48:27,05 --> 00:48:31,43 has thirteen health plans because of collective bargaining agreements sometimes it 684 00:48:31,44 --> 00:48:31,59 is 685 00:48:31,60 --> 00:48:36,74 a take the easy way out and try to transition people off the plane over time but it 686 00:48:36,75 --> 00:48:41,44 really becomes cumbersome when you know multiple plans and nobody is on 687 00:48:41,45 --> 00:48:46,22 a more very small moments we're pretty fortunate even over all those you're trying 688 00:48:46,23 --> 00:48:50,56 to bargain we've stayed but you can sell it here in the interest the time brand 689 00:48:50,57 --> 00:48:50,93 going to talk 690 00:48:50,94 --> 00:48:55,62 a little bit about where. Where we want to look for the future Well we have three 691 00:48:55,76 --> 00:48:57,72 major components they all break down into 692 00:48:57,73 --> 00:49:01,17 a lot of different things and that other people are going to present but we've done 693 00:49:01,18 --> 00:49:04,94 just about everything we know how to do with the health plan we've gotten you know 694 00:49:04,95 --> 00:49:08,94 better discounts and by moving around we've looked at every pharmacy benefit 695 00:49:08,95 --> 00:49:12,61 manager every small component that we can to manage those costs within that health 696 00:49:12,62 --> 00:49:16,90 insurance plan so the whole point of this is what else can we do to encourage 697 00:49:16,91 --> 00:49:21,38 people along the pathway to health because the reality is we've got to control 698 00:49:21,39 --> 00:49:25,05 utilization and we've got to get people doing the right things in the right setting 699 00:49:25,35 --> 00:49:29,31 so we're looking at an employer sponsored clinic here because we want them to use 700 00:49:29,32 --> 00:49:32,64 more cost effective services I think you guys have heard about some of that 701 00:49:32,65 --> 00:49:34,78 endeavor and John is going to talk 702 00:49:34,79 --> 00:49:38,10 a little bit more about that I think but we also are looking at wellness 703 00:49:38,11 --> 00:49:41,96 initiatives city of Auclair For example you going to see that on their on the 704 00:49:41,97 --> 00:49:45,27 survey they're doing it all comes based wellness strategy 705 00:49:45,28 --> 00:49:49,25 a little bit more about that later but literally people are starting to say we're 706 00:49:49,26 --> 00:49:49,76 not going to have 707 00:49:49,77 --> 00:49:52,36 a carrot and stick separately anymore we're going to beat you with 708 00:49:52,37 --> 00:49:56,84 a carrot if you don't comply so there's a little bit more of a of 709 00:49:56,85 --> 00:50:00,31 a dearth of we want to give you the reward but we have to get you to do the right 710 00:50:00,32 --> 00:50:03,97 thing in the right setting at the right time so we're looking at all of these 711 00:50:03,98 --> 00:50:09,29 things together it's not just an individual component any. You know if I describe 712 00:50:09,30 --> 00:50:14,83 things. I know I'm only laughing because my husband works for an employer that 713 00:50:14,84 --> 00:50:18,31 implemented the clinic and that's what their whole whole program and I'm one of 714 00:50:18,32 --> 00:50:23,36 those that get don't want to have to comply so my husband's to the point of you 715 00:50:23,37 --> 00:50:27,32 need to do this this this way because if we don't the premium goes off so you know 716 00:50:27,33 --> 00:50:33,08 he's going to throw me out. Like this. But if I mean 717 00:50:33,09 --> 00:50:37,08 a number of employers have a mandatory Cherry And if you don't take each other 718 00:50:37,09 --> 00:50:41,67 a you're right you can't purchase and the reason is it's the healthy people that 719 00:50:41,68 --> 00:50:46,81 elect not to participate in the ones. Going to be healthier years healthier 720 00:50:46,82 --> 00:50:48,23 lifestyles so I think you have 721 00:50:48,24 --> 00:50:54,53 a lot while you say you owe me going to be your day sometimes that's that's that is 722 00:50:54,54 --> 00:50:58,56 costing the bills but we do want to give those rewards I think every employer wants 723 00:50:58,57 --> 00:51:02,36 a healthier workforce we want presenteeism and said Of all of these other you know 724 00:51:02,53 --> 00:51:07,64 isms that we end up with but the reality is how do you incentivize people 725 00:51:07,68 --> 00:51:12,74 appropriately and I think we're finding with the public and the private sector if 726 00:51:12,92 --> 00:51:14,29 it does it there is 727 00:51:14,30 --> 00:51:18,29 a cost to incentivizing to get any sort of return on that investment you know I 728 00:51:18,30 --> 00:51:21,70 think in council member Fitzgerald you know you hear he hit it right on the head I 729 00:51:21,71 --> 00:51:21,95 think 730 00:51:21,96 --> 00:51:26,81 a lot of the our employees understand that too and that was one of the reasons why 731 00:51:26,82 --> 00:51:31,66 they suggested to city manager off that we go look with the co-pay plan they 732 00:51:31,86 --> 00:51:35,98 understood that if you use the plan more you really should pay more and we're going 733 00:51:35,99 --> 00:51:36,35 to talk 734 00:51:36,36 --> 00:51:40,20 a little bit more about some Yeah we already have unity is only about seven minutes 735 00:51:40,21 --> 00:51:43,81 so we're going to really have some members who are about four or five minutes 736 00:51:43,82 --> 00:51:47,44 rather just talk about where we go from here right here where good point we're not 737 00:51:47,45 --> 00:51:54,05 going to get all the work through so we're about four hours. OK. Employer 738 00:51:54,06 --> 00:51:57,94 sponsored clinics It's very common in the private sector and it's growing in 739 00:51:57,95 --> 00:52:02,40 popularity in the in the public sector I can tell you that we're currently 740 00:52:02,69 --> 00:52:06,31 participating with the county in the school district and researching the potential 741 00:52:06,47 --> 00:52:11,62 for that and. We're going to be looking for proposals and then evaluating those 742 00:52:11,63 --> 00:52:15,57 proposals we can't give you any specific numbers because we have to evaluate that 743 00:52:15,58 --> 00:52:19,69 first but that's what we're looking at the benefits of it are creates more 744 00:52:19,70 --> 00:52:24,52 cooperative solution than just cautious doing more quality time with individuals 745 00:52:24,53 --> 00:52:29,41 coaching versus care and more complete care meets reasonable care standards of 746 00:52:29,42 --> 00:52:35,17 a CA but it's the whole idea is to adopt healthy lifestyles it's really 747 00:52:35,37 --> 00:52:41,59 a stepping stone to wellness and workplace health it helps us control utilization 748 00:52:41,60 --> 00:52:45,44 of health services for chronic illnesses because if we can manage some of those 749 00:52:45,45 --> 00:52:50,27 things on the friend and we're not paying form on the back end. We become the 750 00:52:50,28 --> 00:52:55,61 primary provider and so that you have that relationship that you're creating with 751 00:52:56,38 --> 00:53:00,50 the employee in the primary provider and it creates easy access point for cost 752 00:53:00,51 --> 00:53:06,21 effective care as everybody knows we're tapping it to go there. Sheboygan as as 753 00:53:06,35 --> 00:53:10,66 probably the most experience in this area doing that the city county and school 754 00:53:10,67 --> 00:53:15,61 district all of done it Walker shot just have this approved recently you know clear 755 00:53:15,62 --> 00:53:19,17 is in the process of doing this right within and I think they're 756 00:53:19,18 --> 00:53:23,76 a little bit behind of some of the West Bend does it at the school district level 757 00:53:23,77 --> 00:53:27,69 they did not bring in the county and the city I think there are some issues down 758 00:53:27,70 --> 00:53:31,12 there which if I was in the school what's been the school district I would have 759 00:53:31,27 --> 00:53:35,79 avoided going to them to going to the other agencies and it just sometimes great 760 00:53:35,80 --> 00:53:39,97 match right now of the school district in the county here are very interested in 761 00:53:39,98 --> 00:53:42,08 that the county H.R. 762 00:53:42,09 --> 00:53:46,93 Director was the person who implemented in Sheboygan County so he's very familiar 763 00:53:46,94 --> 00:53:48,46 with it and has been providing 764 00:53:48,47 --> 00:53:54,32 a good deal of resource and you know teaching us how that works things. Really 765 00:53:54,36 --> 00:53:59,30 consider these things really clinic like it's not true it's not like going to the 766 00:53:59,31 --> 00:54:05,73 doctor and the services that I did around them is that correct. 767 00:54:06,84 --> 00:54:11,62 We would identify the most common services that in the services but it's not for. 768 00:54:13,84 --> 00:54:18,49 Significant testing in that thing you know the whole idea of or at least not 769 00:54:18,50 --> 00:54:23,71 initially severe infection right some of our wellness stuff things got there early 770 00:54:23,72 --> 00:54:28,82 the easy labs eventually will get taken care of there so the next like kind of 771 00:54:28,83 --> 00:54:33,38 cover some of that the whole idea is you want to get utilization you want that's 772 00:54:33,39 --> 00:54:36,23 how you get your return on your investment because you're investing in 773 00:54:36,39 --> 00:54:41,05 a clinic you're investing in the cost of that clinic so location access is very 774 00:54:41,06 --> 00:54:45,05 important not only the employee but the dependent needs to buy in any and all 775 00:54:45,06 --> 00:54:49,60 dependents were part of the play need to buy in the employee share for services has 776 00:54:49,61 --> 00:54:54,28 to be priced well enough that they choose to go to our clinic versus another option 777 00:54:54,80 --> 00:55:00,96 so pricing it is very important to steer people towards using it. But we talked 778 00:55:00,97 --> 00:55:04,67 about those selection or the partnership with county and school district vendor 779 00:55:04,68 --> 00:55:09,60 selection is very important you do decide on what levels the numbers you have nurse 780 00:55:09,61 --> 00:55:14,73 practitioners how many physicians physicians assistants ours ours has 781 00:55:14,74 --> 00:55:19,75 a lot to do with utilization do you have something from five pm to eight pm so that 782 00:55:19,76 --> 00:55:22,96 people can go after work bring their kids after work so they don't have to take 783 00:55:22,97 --> 00:55:26,73 them out of school or get out of work to do the thing make it more convenient for 784 00:55:26,89 --> 00:55:32,22 for the employee and their dependents to use that services can be 785 00:55:32,51 --> 00:55:37,06 a primary health services are really to what Tom talked about health coaching 786 00:55:37,07 --> 00:55:39,28 biometric screenings pharmacy there's 787 00:55:39,29 --> 00:55:43,44 a lot of other things you can do there you're not required you can do whatever you 788 00:55:43,45 --> 00:55:47,94 want but you try to do is grab the stuff that takes the most volume that you can 789 00:55:47,95 --> 00:55:54,95 get the best discounts on by providing it yourself. Wellness 790 00:55:54,96 --> 00:56:01,73 programs. Basic programs as well are what we do right now we do 791 00:56:01,74 --> 00:56:07,63 a health risk assessment. The program design is that if you participate in the 792 00:56:07,64 --> 00:56:11,72 health risk assessment instead of paying fifteen percent premium for health 793 00:56:11,73 --> 00:56:15,73 insurance you only pay twelve percent that's all it works the whole idea is to 794 00:56:15,74 --> 00:56:20,82 steer you towards healthy lifestyle initiatives when you've been screened you'll 795 00:56:20,83 --> 00:56:25,51 get notified Here's what we found if you have high blood pressure they'll go or 796 00:56:25,55 --> 00:56:28,74 they'll suggest that you go to a doctor sometimes they say you need to go to 797 00:56:28,75 --> 00:56:33,80 a doctor immediately or you need to go to a doctor within the next two weeks. With 798 00:56:33,81 --> 00:56:39,55 a CA they do allow for premium differential and reduced in toy premium 799 00:56:39,56 --> 00:56:41,83 contributions that that's permitted under 800 00:56:41,84 --> 00:56:47,46 a CA So what we're doing right now is totally OK with what he CA's. 801 00:56:48,83 --> 00:56:52,41 What we want to do is get more participation based one let's get employees to be 802 00:56:52,42 --> 00:56:57,84 more engaged more active in those transition to outcomes based wellness it's not 803 00:56:57,85 --> 00:56:58,03 just 804 00:56:58,04 --> 00:57:01,100 a matter that I got my blood pressure taken it's I do something about it when they 805 00:57:02,01 --> 00:57:05,70 say your blood pressure is up what do you you know you need to do something about 806 00:57:05,71 --> 00:57:12,62 it disease management coaching getting those those types of things. But see. 807 00:57:14,61 --> 00:57:18,61 Through So some considerations that we need to take 808 00:57:18,62 --> 00:57:25,04 a look at is Currently we only offer the health risk assessment to employees do we 809 00:57:25,05 --> 00:57:30,76 want to consider adding spouses and retirees to the health risk assessment Another 810 00:57:30,77 --> 00:57:33,40 consideration is what is the cost of 811 00:57:33,41 --> 00:57:39,20 a vibrant wellness program and then also the return on investment if you do any 812 00:57:39,21 --> 00:57:44,50 type of research on that study suggest to do on some studies suggest three to one 813 00:57:44,66 --> 00:57:50,02 so for every dollar that you spend on wellness your return could be two times or 814 00:57:50,08 --> 00:57:54,03 possibly three times there's also eddies that will suggest it's more. 815 00:57:57,60 --> 00:57:59,43 Just so that you have some sort of 816 00:57:59,44 --> 00:58:04,83 a general knowledge Currently our budget is about fifty thousand and that includes 817 00:58:04,91 --> 00:58:10,42 E.A.P. Services and also the biometric screening and with the E.P. 818 00:58:10,43 --> 00:58:14,53 In the biometric screening we're looking at about forty thousand right there so 819 00:58:14,54 --> 00:58:20,49 again just to give you some basic knowledge of where we're we're currently at. The 820 00:58:20,50 --> 00:58:24,94 current value of the biometric screening and the health risk assessment is like 821 00:58:24,98 --> 00:58:31,02 Mark had said earlier it's three percent savings in premiums so again just so that 822 00:58:31,03 --> 00:58:35,44 you basically understand what that he quits to person go policy is about three 823 00:58:35,45 --> 00:58:37,33 hundred dollars annually for 824 00:58:37,34 --> 00:58:40,97 a dual policy to people is about five hundred seventy dollars in 825 00:58:40,98 --> 00:58:45,02 a family is about seven hundred dollars just so you have some sort of 826 00:58:45,03 --> 00:58:50,93 a reference there. Yes people are taking that out of those three hundred eighty so 827 00:58:50,93 --> 00:58:57,41 . I think we have the right assessment we have five hundred people that. 828 00:58:58,83 --> 00:59:03,59 Take the health risk assessment it's been really high but if the employee is only 829 00:59:04,28 --> 00:59:09,75 and we currently only have eight people that do not participate in the health risk 830 00:59:09,76 --> 00:59:14,59 assessment so it is very very high participation and just to throw 831 00:59:14,60 --> 00:59:21,50 a few more statistics at you. I'll just throw three of them at you right 832 00:59:21,51 --> 00:59:24,25 now we have eighty percent of our population with 833 00:59:24,26 --> 00:59:30,22 a body mass index of over twenty five so that means that we have one hundred that 834 00:59:30,23 --> 00:59:36,77 have less than twenty five another statistic I think that is important to know is 835 00:59:36,78 --> 00:59:42,79 that we as part of the health risk assessment people followed or employees fill out 836 00:59:43,15 --> 00:59:49,40 a questionnaire sixty percent stated that they rarely or never exercise so you're 837 00:59:49,41 --> 00:59:54,52 looking at three hundred of our people five hundred people that take the health 838 00:59:54,53 --> 00:59:58,10 risk assessment three hundred of them rarely or never X. 839 00:59:58,11 --> 01:00:03,82 Or size and just one last two to stick we have forty five percent or two hundred 840 01:00:03,83 --> 01:00:08,45 twenty five employees that have two or more conditions that could lead to 841 01:00:08,46 --> 01:00:15,36 cardiovascular disease stroke or diabetes so I mean all of these things 842 01:00:15,54 --> 01:00:21,15 are very important when we take into consideration our oneness program we don't 843 01:00:21,16 --> 01:00:26,27 want to be punitive unless we're left with no other choice so you know the comment 844 01:00:26,28 --> 01:00:29,90 about beating them with the carrot I think Meat meat that's 845 01:00:29,91 --> 01:00:36,62 a consideration that we need to have so. We broke out we're already OK on 846 01:00:36,88 --> 01:00:42,46 the slope we're clear proof to go to some. More cleaver and. 847 01:00:44,30 --> 01:00:47,58 Well I think it's the wellness part is got to be we've got to get more people 848 01:00:47,59 --> 01:00:51,39 involved in it because it's not just the employees it's the dependency as well and 849 01:00:51,40 --> 01:00:58,15 that was if we know our dependence we're really ignoring half the half the to 850 01:00:58,16 --> 01:01:02,97 health. Care costs well as retirees Yes So we need to set up plan designed to 851 01:01:02,98 --> 01:01:07,67 encourage employees to seek care in the appropriate venue so if it's if we get an 852 01:01:07,68 --> 01:01:10,69 employer sponsored clinic that's one thing to get them to 853 01:01:10,70 --> 01:01:14,61 a specialist if need be we'll do that but we make sure you get to the appropriate 854 01:01:14,62 --> 01:01:20,75 venue and over all gets reduction in medical costs. So future strategies in phase 855 01:01:20,76 --> 01:01:25,15 and really what we talk about next are you know increasing employee engagement 856 01:01:25,22 --> 01:01:30,43 address those eligibility issues what do we do with spouses how do we do YOU do we 857 01:01:30,48 --> 01:01:34,80 address carve outs because those are things that we are paying for right now that 858 01:01:34,81 --> 01:01:39,36 we are not required to do but there are major policy issues for the council. 859 01:01:40,53 --> 01:01:42,02 Employees find your clinic we're going to be 860 01:01:42,03 --> 01:01:45,08 a belly with polls when they come in and make 861 01:01:45,09 --> 01:01:49,92 a river appropriate recommendation based on that when it happens and then wellness 862 01:01:50,08 --> 01:01:53,59 as Suze said the investment gives you a really good payoff so we need to take 863 01:01:53,60 --> 01:01:58,11 a look at investing in that and maybe that's done in conjunction with your clinic 864 01:01:58,85 --> 01:02:05,46 at Camp. OK Where We Go From Here is a question. I just gave you 865 01:02:05,47 --> 01:02:10,84 a ton of stuff on the regular and drawing board with with the limited amount of 866 01:02:10,85 --> 01:02:15,20 time we have I really think we probably need to have a discussion at 867 01:02:15,21 --> 01:02:20,06 a future time future meeting not necessarily to work stop shop session just part of 868 01:02:20,07 --> 01:02:22,46 a direction a city manager at 869 01:02:22,47 --> 01:02:27,38 a future meeting take this please call us with questions on we'll try to answer any 870 01:02:27,39 --> 01:02:30,49 questions you have whether it's about our current plan or where we're going with it 871 01:02:30,81 --> 01:02:35,34 as we get the proposals we'll evaluate them will provide you information on that 872 01:02:35,38 --> 01:02:36,69 we're thinking of maybe doing 873 01:02:36,70 --> 01:02:40,54 a segment said which may take an investment of time but if you want interested 874 01:02:40,77 --> 01:02:45,39 looking at one of these employer sponsored clinics happy to make it available to if 875 01:02:45,40 --> 01:02:51,79 that's what you want to do. The order we want to throw or we're probably faster of 876 01:02:51,79 --> 01:02:54,89 . I'll put them on an agenda was are we do 877 01:02:54,90 --> 01:03:01,01 a follow through. OK we're. To An End Thanks folks thank you sir but if you're 878 01:03:01,02 --> 01:03:03,43 short of a better word you think you'll feel 879 01:03:03,72 --> 01:03:14,10 a little trick. Yeah 880 01:03:14,43 --> 01:03:19,80 yeah yeah. Yeah.